Dentistry and medicine: The great divide

Hezne Ezaty Abu Hasan, 26 Jul 2017

'Did You Know?' seeks to uncover a variety of stories from all facets of medicine and healthcare.

The separation of oral health from medical health is like the gnawing feeling that a toothache brings. It is ever present and upsets the patient until something is done. For as long as healthcare history can remember, the mouth is not part of the body.

Doctors go to medical school and do not ask if the patient is brushing regularly; while dentists go to dental school and do not ask if the patient is exercising regularly. Even in insurance packages, dental care is seen as a fringe benefit – and can be added on to the base medical coverage for an extra fee.

In reality, the health of the mouth and the body is closely related. Gum diseases have been known to set the stage for diabetes, high blood pressure and cardiovascular disease.

Sepsis, a chronic blood infection can possibly be due to a dental infection. In the case of 12 year-old Deamonte Driver in the US – an untreated tooth infection that spread to his brain had led to his demise. His family did not have dental coverage, and he was rushed to the hospital for an emergency brain surgery – but, to no avail.

The historic rebuff

Tracing back history, veteran health journalist Mary Otto reports that the two worlds have always stayed separate. Extracting and fixing teeth were considered a special mechanical skillset, and used to be offered by barber surgeons, who among other things offered cupping and leeching.

In the 1800s, archaic dentistry became a profession – much thanks to a couple of self-taught American dentists, who appealed for dentistry to be part of medicine. They believed that dentistry was more than a mechanical skillset, and deserved status and support like that bestowed upon medicine.

As the story goes, the appeal was rejected, because dentistry was deemed as a field of little consequence. This event was fondly known as the “historic rebuff”.

Thereafter, there have been efforts to integrate the two worlds; but as it had before, the call was unanswered. Organised dentistry fought tooth and nail to keep the separation for the purpose of maintaining autonomy. Otto echoes the reason, crediting the separation to wanting professional independence.

Carving out dentistry from medicine

The biggest consequence of taking out the dentistry slice out of the medicine cake is on how the care is administered and covered by insurance. Many do not have the auxiliary benefits of dental care covered in their insurance package – and as a result, do not get treatment when warranted.

Consequently, emergency departments are seeing a lot of visits for preventable dental problems, like a toothache, that could be easily addressed in a dental office. Emergency departments in the US lose USD2 billion per year and productivity due to oral health visits. Even so, patients rarely get the dental attention they need because dentists are hardly in emergency departments. They will be given some painkillers and still be advised to visit the dentist.

Moreover, dental records and medical records are also kept separately, with no common diagnostic language to link them. This is also a hindrance in trying to research the commonalities between oral health and medical health. As such, oral health is still considered as a problem to be fixed instead of something to be understood and prevented. Essentially, people with oral issues should be seen as people who are suffering from a disease, and not people who fail to care for their oral wellbeing.

Recently, having access to dental care is considered something of status, especially in light of knowing that many do not have dental benefits. Dentists have moved to cosmetic dentistry where the big money lies, providing perfect teeth to those without major dental issues, while the vast majority remains without the basic dental care that could keep them happy and healthy.

Gradually, dentists have moved to cosmetic dentistry where the big money lies – providing perfect teeth to those without major dental issues.

Bridging the gap

The need to bridge dentistry and medicine is imperative and initiatives are being rolled out. One such group is The Harvard School of Dental Medicine, who has brought forth the Initiative to “Integrate Oral Health and Medicine” –bringing together industry leaders to find ways to seamlessly assimilate dentistry into medicine.

The school also established the “Oral Physician Program”, integrating oral health with primary care and family medicine training – thus, creating a new breed of doctors who are well-versed and practising the two fields.

Otto also mentioned the Triple Aim, which was discussed in the medicine world, and should be discussed more in the dental world. It involves bending the cost curve toward prevention, expanding care more broadly and more cheaply, and creating a better quality of care.

Are overlapping surgeries putting patients at risk?
20 hours ago
A new study has added to the ever-increasing body of work that suggests patients of overlapping surgeries are more likely to suffer serious complications compared to surgeries in which the doctor focuses just on one patient. Nonetheless, is this study more credible?